I think it's time for therapy. Help me take MetaFilter's favorite advice.

June 11, 2012 6:58 PM

I think it's time for therapy. Help me take MetaFilter's favorite advice. I keep finding reasons not to do it, or coming up with questions I need to answer first. Please help me answer a few of those questions, and walk me through the process.

I've been thinking for a while that it's time for me to try therapy. I tried it briefly as an angsty teenager who didn't really want to get better, and unsurprisingly I hated it. But now I'm a grownup, and I've realized that I don't have to be depressed, and I actually want things to change.

Background info:

I'm currently in Atlanta, and in my late 20s. The main issue is depression that's been with me since late childhood, and has varied in that time from mild dissatisfaction with life in general to frequent suicidal thoughts. I'm currently in the mild to moderate range of the spectrum for me. The more pressing issues (which certainly are part of the primary one) are lack of motivation, difficulty taking basic care of myself (i.e., eating and sleeping regularly), staying on top of the basic tasks involved in being an adult, catastrophizing, and various similar things. I'm staying afloat right now, but it's hard.

I've finally come to realize that, for instance, being unable to drag myself out of bed in the morning to go to work (to a job I actually quite like) just because I don't want to face the world is not normal, and I don't need to go through life like that. I don't need to be telling myself I'm a failure every time I make a small mistake. I have a really hard time accepting the fact that I'm someone worth taking care of, and it's time for that to change.

My questions:

Should I avoid going through my insurance? I'm already hard to insure on an individual policy; having therapy on my record will only make that worse, right? I'm on a group plan now, and don't really anticipate being off one, but I worry. Any idea what kind of prices I'd be looking at if I don't go through insurance? I doubt I qualify for sliding scale type rates.

How do I find a therapist? I have no idea where to start, or how to figure out if someone's a good fit. Do I call and "interview" the therapist first? Do I just set up an appointment and see how it goes? How do I even come up with a list of people to call?

What else should I know before I start this process? Please walk me through the general steps I should be following here, and what I should be considering.

I'll be keeping an eye on this question, and will follow up through the mods if necessary.

Also, feel free to tell me I'm overthinking this, and I should just go do blank. I'm sure I am overthinking it, but I just don't know what goes in that blank.

posted by anonymous to health & fitness (8 answers total)

I would recommend going through your insurance. I went to an out of network person once and it was about $100/session, which I'm still partially paying off today. With my insurance my sessions are now $5 each. Much better.

To find one, I recommend talking to your PCP. If they're good they should give you a couple names. Then finding a good fit is up to you. Go to a couple sessions and see how you're doing with them.
posted by Lt. Bunny Wigglesworth at 7:09 PM on June 11, 2012 [2 favorites]

The bad news: evasion is illegal
Not going through insurance doesn't rid you of your obligation to list treatment on your individual insurance application. If you omit it, the insurance company will dig it up and use it as an excuse to throw you off the plan should you ever incur catastrophic medical costs (which is the only scenario in which individual insurance will turn out to be worth paying for anyhow).

The good news: evasion is unnecessary
Pre-existing conditions that have caused me to be denied coverage by multiple insurance companies: headaches & acne. WTF?
Pre-existing conditions that have NOT caused me to be denied coverage: depression & anxiety. FTW!
posted by feral_goldfish at 7:20 PM on June 11, 2012 [2 favorites]

I went through insurance and so far, I haven't had any negative repercussions.

To find a therapist, I went through several different resources, trying first to find a psychologist, over a therapist given that psychologists tend to have more schooling. I also searched through my insurance company for approved providers and broke that list down by psychologist. Then, I did extensive internet searching and further narrowed the list based upon styles of the various providers, location and hours.

After that, I called the final few to get a better idea of how they work. I was very happy with my choice after going through that process.

I also spent some time thinking about what I wanted to accomplish in therapy. What was bothering me? What was I hoping to get out of the process?

I don't think you are overthinking the process. Finding the right therapist is a process and when you do find the right one, it's amazing what you can accomplish.

Best of luck.
posted by Leezie at 7:24 PM on June 11, 2012 [1 favorite]

Well, you might be overthinking a bit, but not unreasonably.

I found my current therapist through Psychology Today originally. She does phone interviews with new clients, which is pretty common-- most therapists will do at least one phone or in-person introductory session for free or a reduced rate, to find out if you're a good fit.

My previous therapist was someone I was referred to by another therapist, and she was great. I've also gotten good recommendations from friends in the past.

I have seen a therapist using my insurance, and... I'm not sure if I recommend that whole-heartedly or not. It really depends on your insurance. Mine covers short-term immediate-need therapy, but not ongoing and/or as-needed maintenance therapy. I realized (after years of chronic minor depression with occasional spikes) that it's a pretty big deal for me to have an ongoing relationship with a therapist I feel comfortable with, because it eliminates the barrier of needing to find someone new and go through all the relationship-building work when I'm having a bad patch. For me, keeping that relationship stable is worth paying out-of-pocket. If your employer offers a pre-tax medical expenses program, you may be able to use those funds for therapy, which can help offset the cost.

Having depression on your medical record can make you more difficult to insure individually, but if you anticipate being on group plans that's probably not a huge deal-- and it can be useful to have that info in your medical record, so your GP is aware of it. Asking your GP for a referral is probably a decent idea, at least as a place to start. If your first therapist (or second, or third) isn't a great fit, move on until you find someone who is. Again, I personally think that a good personal fit is the most important part of therapy. I found CBT helpful, so you could consider checking out someone who uses this approach.

The therapists I've had that do sliding-scale pricing have not asked me for any income info-- they've just said "are you comfortable with $X per session?", where X is some number lower than their regular fee. I've paid between $60-$110 an hour for therapy in Portland, OR, and have generally also been able to be reimbursed through my medical expense account.
posted by Kpele at 7:26 PM on June 11, 2012

Pre-existing conditions that have NOT caused me to be denied coverage: depression & anxiety.

This is not a universal experience.
posted by quivering_fantods at 7:26 PM on June 11, 2012

I would use your group insurance. I went to my PCP first and asked for recommendations - the first person was a Horrible fit, I went back to my PCP and they had me consult with the psychiatrist in their office, he sent me to a Great fit. So if the first interview is discouraging, go see someone else. Even with insurance my payment varied greatly - from free to a $20 copay to $95 a session - it's worth it if you can get insurance to pay for some of it.

If you don't have a PCP or are reluctant to go see them, try just searching for local therapists on Psychology Today - the profiles can help you narrow your search.

The first steps are the hardest, but it gets So Much better - my life is improved on innumerable fronts for good therapy. Good luck!
posted by ldthomps at 7:27 PM on June 11, 2012

Schedule an appointment with your regular Dr. for a check up and ask him or her for a reference to a psychiatrist within your insurance system. Make an appointment and get checked out.

I suggest starting with a psychiatrist first because they will be able to help you figure out what you need. Medication? Therapy...etc.

This is a health issue so definitely use your insurance. I've had some counseling a couple of times through my insurance in my adult life and it was no problem at all.

Whatever you do, follow through and try to not feel stigmatized. You've recognized a need and you're pursuing it. Go for it and reap the benefits!

Good Luck!
posted by snsranch at 7:37 PM on June 11, 2012

Does Georgia have a state ombudsman for health insurance? In my state there is a 1-800 number you can call that connects you to a citizen helpline at the state office that regulates healthcare, and they can answer for you all kinds of questions about whether you can be denied individually-purchased coverage for a depression diagnosis (in my state, NO, but they can charge you more, but if they want to charge you more than a really high certain amount, you can get state insurance through the hard-to-insure pool that has some special name).

I ask my GP for a recommendation because they will know someone good, can usually get you a faster appointment, and at least at my GP their computer system can search all the insurers' provider lists to make sure they only refer me to people who are covered by my insurance. Also if you go with a psychologist, your GP and psychologist can work together on medication if it's necessary (whereas a psychiatrist can prescribe directly). I'm of the "try a couple sessions and see how the fit is" school, partly because when you're depressed it can be super-hard to go through all the rigamarole of interviewing providers.
posted by Eyebrows McGee at 7:39 PM on June 11, 2012